Wednesday, January 18, 2017

Seizure management in schools

Terry D, Patel AD, Cohen DM, Scherzer D, Kline J. Barriers to Seizure Management in Schools: Perceptions of School Nurses. J Child Neurol. 2016 Dec;31(14):1602-1606.

The purpose of this study was to assess school nurses' perceptions of barriers to optimal management of seizures in schools. Eighty-three school nurses completed an electronic survey. Most agreed they felt confident they could identify a seizure (97.6%), give rectal diazepam (83.8%), and handle cluster seizures (67.1%), but fewer were confident they could give intranasal midazolam (63.3%), had specific information about a student's seizures (56.6%), or could swipe a vagus nerve stimulator magnet (47.4%). Nurses were more likely to be available at the time of a seizure in rural (17/20) (85%) versus suburban (21/34) (62%) or urban (8/25) (32%) schools (P = .001). School nurses are comfortable managing seizures in the school setting. However, a specific seizure plan for each child and education on intranasal midazolam and vagus nerve stimulator magnet use are needed. A barrier in urban schools is decreased availability of a nurse to identify seizures and administer treatment.

Most children who have a seizure at school do not need to be transported to an emergency department (ED), but many end up there anyway. How can providers help ensure that appropriate seizure management takes place in schools without a trip to the hospital?...
Among the most notable findings about barriers:

38.5 percent of respondents said their school districts required transport to the ED after any convulsive seizure and/or a seizure during which rescue medication was given

Only 63.3 percent of respondents were confident they could correctly administer intranasal midazolam, at least partially because of the difficulty of drawing and giving the correct dose via syringe

47.4 percent were confident they could swipe a vagus nerve stimulator with a magnet
56.6 percent of respondents said they had enough information about a specific students’ seizures and their management

85 percent of respondents were available to respond to seizures in rural schools, while only 32 were available in urban schools

Other findings were more promising. The large majority of nurses, for example, were confident they could recognize a seizure and give rectal diazepam…

Providers at the hospital now make syringes prefilled with intranasal midazolam available to parents, who can supply them to schools. A seizure “action plan” has been developed as part of a child’s electronic health record, which can be given to school staff to help them respond to events.

Those are steps in the right direction, but they do not solve every problem, says Terry. District policies about ED transport, or how accepting a school might be of an action plan, or the number of nurses available in some areas, are all issues that can only be addressed through provider collaboration with education officials.

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